An observational study to determine the status of serum and RBC folate in drug resistant epileptic children at a tertiary care centre in Western Rajasthan, India

Bindu Deopa, Bhawna Chaudhary, Ashish Gupta


Background: Drug resistant epilepsies constitute about 10-20% of childhood epilepsies and treated with higher doses and multiple AEDs. AEDs increases folate metabolism by enzyme induction thus causes deficiency of folic acid.

Objective was to evaluate the effect on serum and RBC folate in children having drug resistant epilepsy.

Methods: In a prospective observational study 83 drug resistant epileptic children of age 6months to 180 months fulfilled the inclusion criteria enrolled in study, from Oct 2014 to Nov 2016 for a period of two years. Serum and RBC folate levels were done in these children. Epileptic children already receiving folic acid supplementation/treatment were excluded from the study. Children with serum folate level <5ng/ml and RBC folate <280ng/ml was considered as folate deficiency.

Results: Total 83 children had drug resistant epilepsy (defined by ILAE). Mean age of children with drug resistant epilepsy was 71.39±49.76 months. 71.08 % were male and 28.91% were female. Mean serum folate in these children was 7.75±2.77 ng/ml and RBC folate 381.63±164.54 ng/ml which was significantly lower as compared to healthy children or epileptic not receiving AEDs. 14.45 % children in drug resistant epilepsy had serum folate <5ng/ml while 20.89% were found to be RBC folate deficient (RBC level <280ng/ml).

Conclusions: Antiepileptic drugs are associated with lower blood folate status which deteriorates further with increasing number and doses of AEDs in drug resistant patients. Therefore blood folate monitoring should be done in all children on AEDs on regular intervals and should be considered in the etiologic differentials of drug resistant epilepsy.



Drug resistant epilepsy, Folic acid, Refractory seizure

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